Case:Maja
Diagnosis: February 2005 No insulin since January 2, 2006! Current insulin: Levemir 1 U BID started Nov 30 2005 Previous insulin: Lantus 0.5 U in the AM, 0.5 or 0.25 U in the PM. Nov 3 2005 - Nov 29 2005 Oral treatment: Glipizide February 2005 - November 2005 Maja is born in 1995 and was diagnosed with diabetes in February 2005 after having received prednisolone and Depo-Medrol for eczema. She seems to be allergic to fish among other things and in order to clear up her rash quicker (she had scratched herself bloody), the vet gave her a Depo-Medrol shot and put her on 5 mg prednisolone daily for 2 weeks. Together with elimination of all fish-containing food from her diet, Maja's skin healed, but she started to eat, drink and pee excessively. Maja did not present with ketones, nor extremely high BG and fructosamine, so the vet at the animal clinic rx:ed Glipizide + M/D or A/D (Maja'd lost some weight from the diabetes) and said insulin wasn't recommendable in cats anyway. Glipizide worked well for a couple of months, then her BG and fructosamine got higher during summer/early fall. She had a dental and our new vet increased Glipizide, and said that we'd switch to insulin if she didn't show any improvement during the next 2 weeks. We had asked another vet (the one that did the dental) about her pronounced limping and hindleg weakness, if it could be diabetic neuropathy, but the other vet said no. New vet said it could be. Vet wanted prescribed Caninsulin, but since my sister was on Lantus and we'd read the papers about Lantus in cats, we said we wanted to try Lantus instead. We also saw that the food we'd been feeding in the past, MJAU (a Swedish brand), was much lower in carbs and had better ingredients than the food the old vet prescribed, so we bought MJAU again. Her BG the days right before starting insulin were in the high 200's/low 300's (BG at the vet a couple of days earlier was in the 400's and fructosamine 600), so we decided to start her out on 0.5 U. For the first while Lantus was OK, and she got up to 1 U BID for a while, but then she started getting too steep and early drops and the dose had to be reduced to 0.5 U. She also had to skip or delay shots since her BG often was too low (in this context) to give Lantus. Her BG curve looked very much like the Caninsulin curve on the manufacturer's website. There is only syringes with 1-U steps available here, and it was difficult to draw up less than 0.5 U insulin, so when we tried doing that, the dosage became very unreliable. My sister happened to switch to Levemir right then, and we decided to switch over Maja too. There wasn't much data about Levemir at that point; just some from Jock and Winkie. Maja started on 0.5 U Levemir to be on the safe side, since she was so sensitive to Lantus. After a week, her dose was raised to 1 U BID, and she started getting better and better BG's. We noticed pretty soon that it gave her smooth BG curves, a gentle drop and long duration. 1 U BID was the perfect dosage for her. She could remain in the low 100's for most of the cycle, and since she didn't any steep drops, we were able to give her insulin with preshots in the low 100's, as well as give insulin earlier in the cycle if needed. After 12 days with numbers like these, we noticed she got longer and longer duration from Levemir as well as lower nadir, so her dose was reduced to 0.5 U BID. Then it was reduced to 0.5 U SID. January 3, we decided to see what would happen with her BG if we skipped a shot. If her BG would be around 180 or more, we said we'd give her insulin to bring her down. Her BG went up and down on its own for a couple of days, mainly between 95 and 140, then it started getting lower and lower as well as fluctuating less until it settled between 54 and 80. Majas treatment log Nov 3, 2005 After inadequate results with Glipizide (as well as elevated liver enzymes from Glipizide) and low-carb diet, Maja started Lantus today. We had already started hometesting prior to that, but we were still worried about hypos. Regarding Glipizide, initially it worked well, but after a couple of months Maja deteriorated, lost weight and developed neuropathy. Despite that she had a dental cleaning and two extractions and the Glipizide dose was raised, she still didn't improve. Her BG was in the 400's and fructosamine around 600. Needless to say, the Glipizide had to go. If we'd known better back when Maja was diagnosed, we'd have skipped the Glipizide and tried insulin instead. The vet we'd talked - the same that did Maja's teeth - to was also a bit negative about insulin and said Maja'd have to be hospitalized for at least a week until they had her adjusted, and that it was very different from human diabetes, so we couldn't just apply our knowledge about human diabetes on Maja. Then Maja got a new and much better vet at the same clinic. While the new vet doesn't have any experience with Lantus or Levemir (most cats here get Caninsulin/Vetsulin), she was interested in reading the papers we gave her, as well as encouraging about home testing. She also said it wasn't necessary with a week's hospitalization; since we already were familiar with diabetes and had all "equipment" at home already, it'd be less stressful for Maja if we started the insulin at home, monitored Maja closely and kept in touch through phone. However, the vet wasn't keen on prescribing Lantus since she wasn't familiar with it, just Vetsulin, so Maja gets her Lantus from my diabetic sister, which the vet was OK with. I also believe she didn't want to go against the clinic's policy since she was just temping for another vet on maternity leave, which is fully understandable. She did prescribe U-100 syringes so that we could administer Lantus. The first days we had 0.5 U Lantus SID, and then 0.5 U BID. Nov 7 Maja's nadir BG was 149, and after a few days, her nadir was down to around 90. Before Lantus, her BG would vary from 250 to 400's. Maja's neuropathy seems to have resolved considerably, and she's even stood on her hindlegs again. She also enjoys chasing the other two cats and jumping over them in order to scare them. When her BG drops quickly, she often gets very lively and runs up and down the stairs, so we usually spot-check her then to make sure her BG hasn't dropped too low. She's very patient and doesn't mind ear-pricking or insulin injections at all. Only downside is that Maja is thin - just 3.8 kg/~8 lbs and doesn't have much fat to pinch, which makes administering insulin difficult. She's gained some weight since her BG got under control, though, and hopefully she'll gain some more. Dec 1, 2005 Maja started Levemir yesterday at 0.5 U BID. My sister switched from Lantus to Levemir in order to get more stable BG and reduced frequency of hypoglycemia. According to my sister's endocrinologist, Levemir is gentler than Lantus, and usually gives a more even blood glucose curve - in humans at least. Lantus worked very well for Maja with the exception that 0.5 U would drop her BG at least 180 mg/dl(10 mmol/l) in 3-4 hours regardless of her preshot BG. Then her BG would stay relatively flat for a couple of hours and go up at around +10-11 hours. Because of this, we had to tinker a lot with Maja's insulin dosing, which is difficult since we only have syringes with 1-unit steps. Hopefully Levemir will give Maja a more gentle drop and a flatter glucose curve. Spotchecks today look promising so far. Dec 5, 2005 In contrast to Lantus, Levemir keeps Maja's BG pretty much at a constant level throughout the day. 0.5 U Levemir BID kept her BG at around 13-15 mmol/l (235-270 mg/dl) all day. Yesterday, we raised her dose to 1 unit in the morning and kept the PM dose at 0.5 units, which gave her a BG around 7.9 to 11 mmol/l (142-198 mg/dl) all day both yesterday and today. In a week or so, we'll decide if Maja's dose has to be adjusted again. We've also noticed that Levemir doesn't lower Maja's BG as abruptly as Lantus did, and we've even been able to give Maja insulin with a preshot BG of 7.9 (142). Of course, we're still in the regulation phase, but we do feel Levemir is a much better insulin for Maja than Lantus was. Dec 18, 2005 Levemir seems to be great for Maja! Her BG is much more stable than with Lantus -for example, the other day it was between 7 (126) and 8.4 (151) all day. We are able to give her a full unit, which means we can use the Levemir pen and don't need to try measuring up half-units with a syringe. Maja's neuropathy seems to have resolved completely. When her diabetes was uncontrolled, i.e when she was on Glipizide, she was only able to take a few step before needing to rest, and she wasn't able to jump up on the windowsills and on the TV anymore. Now she bolts up and down the stairs, as well as jumps up everywhere. Jan 7, 2006 Maja hasn't taken any insulin since Jan 2! Prior to that, her dose had to be reduced to 0.5 U SID from her earlier 1 U BID. She is very active and playful, and her fur looks better than it has done in a long time. Maja and the other cats are fed low-carb canned food by "controlled free-feeding", i.e leaving food out for 1-2 hrs a couple of times a day. At random spot-checks during the last couple of day, her BG has remained between 4.5 (81) and 7 (126) despite that she sometimes just has eaten shortly before checking. Feb 12, 2006 Still no insulin! Despite her age, Maja is as energetic as a young cat, and she's regained all weight she lost while the diabetes was uncontrolled. We check her BG every 3 days to be on the safe side, but it is hovering between 3.5 (63) and 4.5 (81). Mar 2, 2006 Today is 2 months since Maja had her latest insulin injection. Her BG is controlled twice a week, and still remains between 3.5 (63) and 4.5 (81). She goes out in the garden wearing a harness - just like a dog - and earlier even the first eyelet was too loose for her, but now the second eyelet fits her well. I estimate she has gained nearly two pounds, mainly in muscle. While she is still slim, she looks healthy rather than gaunt. June 3, 2006 Since Maja's BG has been stable for several months now and she still doesn't need any insulin, we just check her BG once every 2 weeks or so. It stays in the same range as always, but we are very strict with feeding the cats nothing but low-carb canned food and some raw. Oct 20, 2006 We switched to raw-only a couple of months ago because of Maja's food-related problems (dermatitis and diarrhea). She is now on a chicken-based raw diet, which she loves. The novelty of getting raw meat at every meal still hasn't worn off, and Maja will scarf down very large amounts if we don't supervise her. When she manages to steal the other cats' food and empty all three bowls, she gets pronounced food spikes; up to 7-8 (130-140-ish) from her usual 3-4.5 (54-81). Nov 12, 2006 Since we increased the fat in Maja's food by adding more chicken hearts, she doesn't get food spikes anymore. She feels full earlier, and doesn't eat as much as when she gets food with lower fat percentage. Dec 22, 2006 The raw food is working very well, both in controlling her diabetes as well as preventing her dermatitis and stomach problems. Maja is still very happy about her chicken-based diet. She used to get diarrhea - sometimes bloody - as well as vomit from much food. Particulary food containing grains gave her problems, but now her stools are normal and she doesn't vomit except for hairballs. She will get to taste some lamb and turkey, and if she tolerates that (and will eat it), we will incorporate that too in her diet. March 8, 2007 Not much news; Maja's BG is in the same range as usual, and she's doing well on her raw food diet. We've introduced turkey, which the all three of the cats love. Category:Regulated cases Category:Remission cases Category:Female cases Category:Feline cases Category:Oral med casesCategory:Levemir cases Category:Lantus cases Category:low-carb cases Category:Neuropathy cases Category:Tight Regulation casesCategory:Oral med casesCategory:Neuropathy casesCategory:Levemir casesCategory:Remission casesCategory:Feline casesCategory:Female casesCategory:Low-carb casesCategory:Feline female casesCategory:Feline low-carb cases Category:Feline neuropathy cases Category:Steroid-induced cases Category:Feline Oral med cases Category:Feline Levemir users